Copay Tips

  • You are typically required to pay your copay to your doctor’s office at the time of your visit
  • The office visit copay is a set dollar amount (e.g. $15 per visit)
  • Your deductible may not apply, depending on your health plan design

You will not pay copays for preventive care office visits. Copays are for the office visit only, and do not cover any additional services you might receive during your visit (e.g. lab work or X-rays). Any additional services are subject to your deductible and coinsurance, until you reach your out-of-pocket limit. Here are examples of office visit types and the applicable copays.

Office Visit Type

$15 Primary Care Visit

$25 Specialty Visit

Family Practice

 

General Practice

 

Internal Medicine

 

Gynecology/OB

 

Midwives
(if your plan provides in-network midwives)

 

Nurse Practitioners

 

Physician Assistant

 

Pediatrics

 

Urgent Care

 

Chiropractic

 

Home Health Visit

Subject to deductible and coinsurance

Subject to deductible and coinsurance

Palliative Care Visit


For PCP Only


For Specialist Only

Vision Exam

 

Pre/Postnatal Visits

✔*
For family practice with obstetrics or OB/GYN

✔*
For maternal/fetal specialist

Mental Health Visits/Therapy

 

Physical Therapy

 

Occupational Therapy

 

Speech Therapy

 

Other Practitioner

 

 

*If all prenatal visits are billed as a package at the end of pregnancy, then your deductible and 10% coinsurance apply. Check with your doctor’s office for more information.

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